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Clinical Risk Factors and Prognostic Impact of Osteoporosis in Patients With Chronic Heart Failure

Satoshi Katano 1Toshiyuki Yano 2Takanori Tsukada 3Hidemichi Kouzu 2Suguru Honma 4Takuya Inoue 1Yuhei Takamura 1Ryohei Nagaoka 1Tomoyuki Ishigo 5Ayako Watanabe 6Katsuhiko Ohori 2 7Masayuki Koyama 2Nobutaka Nagano 2Takefumi Fujito 2Ryo Nishikawa 2Hiroyuki Takashima 8Akiyoshi Hashimoto 2 9Masaki Katayose 10 11Tetsuji Miura 2

Circ J2020 Oct 28. doi: 10.1253/circj.CJ-20-0593. 

Abstract

Background: The clinical significance of osteoporosis in chronic heart failure (CHF) remains unclear.Methods and Results:A total of 303 CHF patients (75 years, [interquartile range (IQR) 66-82 years]; 41% female) were retrospectively examined. Bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by using dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when the BMD at any of the 3 sites was <70% of the Young Adult Mean percentage (%YAM). The prevalence of osteoporosis in CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74-86] vs. 72 [IQR, 62-80] years), included a large percentage of females, had slower gait speed and had a lower body mass index. Multivariate logistic regression analysis indicated that sex, BMI, gait speed, loop diuretics use and no use of direct oral anticoagulants (DOACs) were independently associated with osteoporosis. Kaplan-Meier survival curves showed that the rate of death and heart failure hospitalization was higher in patients with osteoporotic BMD at 2 or 3 sites than in patients without osteoporosis (hazard ratio 3.45, P<0.01). In multivariate Cox regression analyses, osteoporotic BMD at 2 or 3 sites was an independent predictor of adverse events after adjustment for prognostic markers.

Conclusions: Loop diuretics use and no DOACs use are independently associated with osteoporosis in CHF patients. Osteoporosis is a novel predictor of worse outcome in patients with CHF.